HIV & DEPRESSION

1. HIV & DEPRESSION Jordan Lewis, MSW RSW St. Michael’s Hospital, Toronto Judy Gould, PhD Canadian Working Group for HIV and Rehabilitation Mar. 11, 2009

2. What is Depression? • More than ‘feeling bummed’ • Mild, Moderate, Severe • Biological vs. Psychosocial

3. Why Depressed? • Loss • Dependency • Change • Identity

4. So what can you do? • Be Genuine. • Consideration • Confidence • Transparent

5. Theoretical Foundations • Solution Focused Therapy • Narrative Therapy • Cognitive Therapy

6. Solution Focused Therapy • Looking for the solutions, not the problems. • Focus on the present and future, not the past.

7. Solution Focused Therapy • The Miracle Question: • “This evening you get tired and go to sleep. In the middle of the night, when you are asleep, a miracle happens and all your problems have disappeared. But because it happened over night, nobody is telling you that the miracle happened. When you wake up the next morning, how are you going to discover that the miracle happened? What else are you going to notice?”

8. NARRATIVE THERAPY • RESPECTFUL • NON-BLAMING • PEOPLE AS EXPERTS • PROBLEMS SEPARATE • PEOPLE HAVE MANY INTERNAL RESOURCES THAT REDUCE THE INFLUENCE OF PROBLEMS

9. NARRATIVE THERAPY • THERAPIST IS: • ALWAYS CURIOUS • ASKS QUESTIONS ALWAYS IN COLLABORATION

10. NARRATIVE THERAPY ALTERNATE STORIES • HOW THE CLIENT WANTS TO LIVE THEIR LIFE. • EXTERNALIZATION – LANGUAGE • CONTEXT OF THE PERSON’S LIFE • EXPLORE RELATIONSHIP BETWEEN THE CLIENT AND THEIR PROBLEM

11. NARRATIVE THERAPY UNIQUE OUTCOMES • ANTHING THAT THE PROBLEM WOULD NOT LIKE • UP TO THE CLIENT TO DETERMINE • UTILIZE OTHER OPINIONS TO VERIFY UNIQUE OUTCOMES

12. COGNITIVE THERAPY • DIFFERENT ANGLES OF A PROBLEM • POSITIVE, NEGATIVE AND NEUTRAL • CLIENT FEELS THOUGHTS BEYOND THEIR CONTROL • CONTROL OVER THOUGHTS

13. COGNITIVE THERAPY • NOT JUST THOUGHTS NEED TO CHANGE • NEGATIVE VIEW OF: SELF, WORLD, FUTURE • IDENTIFY MOOD – ONE WORD • HELP TO SET GOALS

14. COGNITIVE THERAPY • GATHERING EVIDENCE THAT SUPPORTS AND NOT SUPPORTS NEGATIVE THOUGHTS • CONSIDER EVIDENCE THAT CONTRADICTS NEGATIVE THOUGHTS

15. COGNITIVE THERAPY • REFRAMING

18. Transference/Counter-transference • Definition • Own your feelings • Dealing with the ‘difficult client’ • Black Hole

19. Dealing with ‘Difficult Client’ • Don’t mean to be ‘difficult’ • Threaten/push your buttons • Shift your thinking • Survival – They do it well

20. Dealing with the ‘Difficult Client’ • Redirect • Set firm limits • Try to remain professional

21. Trust yourself • Talk to others • Self-Care

22. Compassion Fatigue • The stress resulting from helping or wanting to help a traumatized or suffering person (Figley, 1995).

23. Signs of Compassion Fatigue • Sadness, depression, sleeplessness, generalized anxiety • I have wished I could avoid working with some therapy clients • I have felt that my clients dislike me personally • I am unsuccessful at separating work from personal life

24. Meditation • Meditation: the self regulation of attention, in the service of self-inquiry, in the here and now. • The techniques of meditation are categorized by focus such as “mindfulness” (field) or "concentrative“ (object) meditation as well as techniques that shift between the field and the object.

25. Mindfulness Meditation • Jon Kabat Zinn defines mindfulness as: “the awareness that emerges through paying attention, on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment.”

26. Mindfulness-Based Stress Reduction (MBSR) Program • 8-10 weeks • 2.5 hour group meeting per week • Day of silent meditation • Home practice including daily meditation and yoga (45 minutes) as well as written reflections

27. MBSR Effect on Health Status • A meta-analysis revealed: • 64 empirical reports, 20 studies, 1605 participants • Examined data on short-term effects of MBSR on mental and physical health • across populations e.g., fibromyalgia, cancer, depression, anxiety • Significant medium strength effect size for both mental (quality of life, depression, anxiety) and physical health (sensory pain, physical impairment, functional quality of life) parameters across populations • Research still needed to investigate long-term benefits of MBSR Grossman, Neimann, Schmidt & Walach (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35-43.

28. MBSR and HIV • MSBR group showed significant increases mood, functional health, and natural killer (NK) cell activity persisting at 3-months (Robinson, Mathews, Witek-Janusek, 2003). • Indication that mindfulness meditation training can buffer CD4+ T lymphocyte declines in HIV-1 infected adults (Cresswell, Myers, Cole, Irwin, 2008). • Improvements in perceived stress and fatigue and also depression, tension, anger, confusion, and natural killer cell number (Robinson, 2002).

29. MBSR for Health Professionals • A self-care strategy for health professionals and as a way to improve client/practitioner communication • The goals of mindful practice are to be aware of one’s own mental processes as well as what is occurring around oneself and thereby be able to act with compassion (italics mine). Irving, Dobkin, Park (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction. Complementary Therapies in Clinical Practice, 15, 61-66.

30. Benefits for Health Professionals • Decreased stress and distress, negative affect, rumination, anxiety, emotional exhaustion, burnout, health-related complaints • Increased positive affect, life-satisfaction and self-compassion, mood, empathy • No changes in empathy • No changes in salivary cortisol